A 74-year-old Baltimore veteran recently informed me that the Veterans Administration is requiring him to manually split his daily Zocor pill as a cost-saving measure. The VA hopes this strategy will lower its pharmacy expenditures because drug companies often base their prices on the number of pills rather than the dosage. This means that the VA can save money by purchasing fewer tablets at stronger dosages. For our nation's elderly veterans, this policy is penny-wise and pound-foolish.

    The VA recently decentralized its health care system into 22 networks called Veterans Integrated Service Networks (VISNs). VISN-5, which encompasses Maryland, has very specific guidelines regarding tablet splitting. They include requirements that:

• a health care professional provide one-on-one counseling for every patient; 
• patients demonstrate their ability to split a tablet; 
• patients be issued a tablet splitter; 
• patients indicate their willingness to use this method.

    Unfortunately, the VISN-5 violated its own rules when it came to my constituent. Instead, this veteran was never counseled about the new procedure, was never told that the new regimen was optional, and was never issued a splitter.

    In fact, he received his monthly mail-order shipment on schedule with no accompanying letter or flyer explaining that his dosage had been doubled. Fortunately, he noticed the label's small print indicating the changed dosage before he ingested the pills. Because he needed to take his medication immediately -- and to avoid an overdose -- he was forced to cut the tablets with a kitchen knife.

    In the course of my inquiry, I also found that no two VISNs have the same policy. In fact, 10 networks have no formal tablet-splitting policy whatsoever. I have registered a complaint with the Department of Veterans Affairs, and I have been assured that they will rectify the situation for this veteran. While I am pleased to hear that, the overall problem remains unaddressed -- that the nation's veterans have not been fully informed in advance of their rights concerning tablet splitting..

    I have called on the VA to establish a national policy detailing which medicines may be split, for which patients this tablet-splitting is deemed suitable, and a formal system for educating patients and providing appropriate counseling. I have also called on the VA to make tablet splitting optional for all veterans. 

    In reality, many older veterans have difficulty taking accurate dosages of medications that don't require splitting. We should take great care in deciding who might be a good candidate for tablet-splitting.

    We can all appreciate the VA's desire to make the most of every health care dollar, but savings cannot come at the expense of good medicine or common sense. Veterans should be given the option of splitting their tablets and they must be fully informed of their rights.